Thursday, April 7, 2016

While controlling blood pressure, blood sugar
and LDL-cholesterol levels reduces the risk of cardiovascular disease in
people with diabetes, only 7 percent of diabetic participants in three
major heart studies had recommended levels of these three factors,
according to research from the Heart Disease Prevention Program at the
University of California, Irvine School of Medicine.

The findings
illustrate the need for persons with diabetes to better manage their
blood pressure, blood sugar and LDL-cholesterol levels, which are prime
indicators of future cardiovascular disease. The diabetic participants
surveyed in the UCI review were enrolled in the three heart studies
between the late '80s and early 2000s, when treatment was not as good as
it is now. Still, more recent data show that only 25 percent of
Americans with diabetes achieve all three of these targets.

The
good news is that those in the heart studies who did control all three
factors had a 62 percent lower risk of developing cardiovascular
disease, according to Nathan D. Wong, lead author of the UCI report,
which appears online in Diabetes Care.

"But we have done a dismal
job nationally at getting most of our patients with diabetes controlled
for even just these three measures," said Wong, director of the Heart
Disease Prevention Program and a cardiology professor at UCI.

"Since
cardiovascular diseases - including coronary heart disease, stroke and
heart failure - are leading causes of death for people with diabetes,
these findings underscore the value of achieving target or lower levels
of these modifiable risk factors," he added.

The researchers compared measurements of
the three key factors to American Diabetes Association guidelines that
were in effect at the time - blood pressure under 130/80 mmHg, LDL (or
bad) cholesterol less than 100 mg/dL and blood HbA1c (glycated
hemoglobin) under 7 percent. Forty-one percent of the study group were
on target in one of the three categories; 27 percent had achieved two of
the benchmarks; but only 7 percent met the recommended scores in all
three.

Study participants' control of individual and composite
factors was also examined in relation to the occurrence of new
cardiovascular events (including heart attacks, coronary deaths,
strokes, heart failure, percutaneous interventions and bypass surgeries)
over an average follow-up of 11 years.

Wong said that proper
management of any one factor translated to a 36 percent lower risk,
proper management of any two factors was linked to a 52 percent lower
risk, and proper management of all three factors correlated to a 62
percent lower risk of cardiovascular events compared to those without
any factors controlled.

Blood pressure management appeared to
benefit African Americans and women more than other ethnic groups or
men; however, the converse was true for LDL control.

"Our
analysis of three large U.S. cohorts including persons in whom diabetes
has been diagnosed shows those who were at target levels for HbA1c,
blood pressure and LDL to have substantially lower risks for
cardiovascular disease than persons with diabetes who were not at target
levels for such factors," Wong said. "These findings emphasize the
importance of composite control of these modifiable risk factors to
better address the cardiovascular disease risks seen in persons with
diabetes, the need for the development of healthcare strategies to
better ensure such management, and the need for studies to evaluate and
eliminate barriers to risk factor control in persons with diabetes."